1407890056 NPI number — DR. TAMMIE LAJUANA ADAMS DMD

Table of content: DR. TAMMIE LAJUANA ADAMS DMD (NPI 1407890056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407890056 NPI number — DR. TAMMIE LAJUANA ADAMS DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
TAMMIE
Provider Middle Name:
LAJUANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
TAMMIE
Provider Other Middle Name:
LAJUANA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407890056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2604 S VERMONT AVE
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90007-2298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-731-3333
Provider Business Mailing Address Fax Number:
323-731-7626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20707 ANZA AVE
Provider Second Line Business Practice Location Address:
APT # 271
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90503-2925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-247-7235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3094 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 56262CA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00660254 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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